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Background: There are few reports on drug use in patients while hospitalised and none regarding management or clinical outcomes. Aims: To describe cases of drug use by inpatients requiring an urgent clinical response. Methods: We retrospectively reviewed cases at a teaching hospital in Sydney, Australia, from February 2019 to March 2021. Results: Thirty cases were identified, with no deaths. Two patient groups were identified: (i) substance use disorders, using illicit drugs and (ii) self‐harm history, using prescribed or over‐the‐counter drugs. Management involved cardiac monitoring (40%), intensive care (30%), charcoal (20%), antidotes (20%) and intubation (13%). Discharge was planned in 22 of 30 patients, against medical advice in four and directed by medical staff in four. Conclusions: Inpatient drug use requiring an urgent clinical response was infrequently recognised but presents a risk of harm to patients and staff and increases service utilisation and costs. Both harm reduction and systematic approaches guided by institutional policy are recommended. Using these events as reachable moments to address driving factors may modify patients' risk from future events. [ABSTRACT FROM AUTHOR]

Background: Vestibular migraine (VM) is a common cause of recurrent vertigo. Migraine headache preventative therapies are currently prescribed to control vertigo symptoms in VM. Clinical trials of nutraceuticals for migraine headache prevention have shown positive outcomes, but, to date, there have been no studies to assess their effectiveness in the management of VM. Aims: To report the effects of nonprescription therapy management on VM symptoms. Methods: We undertook a prospective, questionnaire‐based assessment of patients diagnosed with VM between November 2019 and August 2021 at two Sydney tertiary referral clinics. Patients were advised on optimising sleep, hydration, exercise and nutrition and instructed to use an over‐the‐counter combination product containing riboflavin 200 mg, magnesium 150 mg, coenzyme Q10 75 mg and feverfew 200 mcg. Symptom severity and frequency were assessed using the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Score short‐form (VSS‐sf) and two visual analogue scales for severity (VAS‐s) and frequency (VAS‐f) before and 3 months after commencing treatment. Result: In 82 participants (78% female; mean age, 44 ± 14 years) we recorded a decrease in DHI (mean, 16.8 [95% confidence interval (CI), 12.8–20.9], VSS‐sf (9.3, 7.1–11.5), VAS‐s (3.0, 2.2–3.8) and VAS‐f (2.8, 2.1–3.4), equating to an improvement of 44.1%, 44.9%, 44.1% and 38.9% for each measure respectively. On the DHI and VSS‐sf, 41 (50%) and 44 (53.7%) patients showed improvement in their symptoms; 39 (47.6%) and 36 (43.9%) patients noted no change and two patients reported worsening. The supplement was well‐tolerated. Conclusions: The results provide preliminary evidence that VM symptom frequency and severity can be reduced by using nonprescription therapies. [ABSTRACT FROM AUTHOR]

Aim: To investigate changes in the clinical characteristics of patients who abused benzodiazepine receptor agonists (BZRA) or over‐the‐counter (OTC) drugs before and after COVID‐19 based on the 2018 and 2022 data of the "Nationwide Psychiatric Hospital (NPH) Survey on Drug‐related Psychiatric Disorders." Method: A total of 446 and 155 cases, and 435 and 273 cases, who mainly abused BZRAs or OTC drugs, respectively, were extracted from the database of the two NPH Surveys. Demographic variables, education, employment, criminal record, drug use during the previous year, psychiatric diagnosis, and types of abused drugs were compared between 2018 and 2022. Result: A comparison of BZRA abusers revealed a decreased number of users during the previous year and an increase in the comorbidity rate of other disorders (F3 and F4 in ICD‐10) in 2022. Etizolam, flunitrazepam, triazolam, and zolpidem were used most in both years, with an increase in zolpidem and a decrease in triazolam in 2022. A comparison of OTC drug abusers revealed a higher proportion of women and young patients in 2022. An increase in the comorbidity rate of F3 and F9 and a significant increase in the use of dextromethorphan products were observed in 2022, although codeine products were in the majority in both years. Conclusion: By comparing NPH Surveys before and after the COVID‐19 pandemic, both BZRA abusers and OTC drug abusers present complex pathologies, requiring tailor‐made treatment. The younger OTC drug abusers were particularly evident among women, and the abuse of dextromethorphan‐containing OTC drugs has increased alarmingly. [ABSTRACT FROM AUTHOR]

This document is a part of the Pharmacotherapy Self-Assessment Program (PSAP) and provides information on the acute management of prescription and nonprescription drug overdoses. It emphasizes the importance of supportive care, exposure history, and understanding toxidromes in guiding treatment decisions. The article discusses the treatment paradigm in toxicology, including decontamination methods, enhanced elimination techniques, and focused antidotes. It recommends consulting toxicologists or poison centers for guidance in managing drug overdoses and highlights the value of involving poison centers and toxicologists in patient care. The document also provides information on the management and treatment of specific drug overdoses, such as Type 1 antiarrhythmics, diphenhydramine, bupropion, digoxin, and various toxic substances. It covers symptoms, treatment options, and the importance of early toxicologist involvement. Additionally, the document presents clinical cases to guide healthcare professionals in making appropriate treatment decisions. [Extracted from the article]

Over‐the‐counter (OTC) local anesthetics have historically been used to alleviate pain in several common conditions including toothache and sore throat. With a rise in chronic conditions and an aging population, there has been an increase in associated chronic pain‐related disorders. Individuals with chronic pain often seek OTC treatments for quick and accessible pain relief. There are several common OTC local anesthetics, including benzocaine, lidocaine, and dibucaine, which are readily available to patients in several formulations. In order to appropriately advise patients on the use of local anesthetics, it is important to understand their key characteristics, including the mechanism of action, clinical properties, pharmacokinetics, clinical applications, and adverse reactions, which may occur. [ABSTRACT FROM AUTHOR]

Self‐selection studies assess participants' ability to use label information to decide if a proposed nonprescription drug is appropriate for their use. The optimal use of information from participants' responses in these trials has not been studied. Data from a self‐selection study for a progestogen‐only contraceptive pill (norgestrel 0.075 mg tablets, Opill) were analyzed. Participants (1772 evaluable participants) were provided with the proposed drug facts label and asked sequentially: (1) Given what you have read on the label and your own health history, is this product okay or not okay for you to take home today and start to use?; (2) Why or why not?; (3) Would you like to purchase Opill today to take home for your own use?; (4) Why or why not? The Per Guidance Analysis based on the US Food and Drug Administration's Guidance considered only the response to the first question as defining a selector. The Complete Analysis considered the responses to all four questions to determine a selector. The Per Guidance Analysis characterized 1597 participants as selectors, whereas the Complete Analysis identified 1180 participants as selectors. The decrease in selectors reflected participants who responded "okay" to the initial question but "no" to purchase question while providing rational explanations for their shift in responses. The results support the use of all available information when assessing a participant's intent in self‐selection studies for nonprescription drug candidates. The findings are discussed in the context of findings from the social cognitive and communication sciences. [ABSTRACT FROM AUTHOR]

Background: Codeine‐containing compound analgesics (CCCAs) are associated with dependence and, when taken in excess, significant risks of harm. A previous audit showed significant costs related to admissions for gastrointestinal (GI) complications of CCCA. Based on this and other evidence of harm, the Australian Therapeutic Goods Administration changed CCCAs to prescription only in 2018. Aims: We aimed to identify the costs associated with codeine‐related GI complications and whether the schedule change in 2018 led to a reduced clinical and financial strain on the health care system. Methods: We conducted an audit of GI admissions and associated costs of CCCAs at a tertiary teaching hospital in Adelaide between 2016 and 2020. Patients were grouped by 2‐year time periods before (group 1) and following (group 2) schedule change. Costs for the index presentation were multiplied for subsequent presentations. Costs and outcomes were compared for groups (standard statistics; P value < 0.05 significant.) Results: Three hundred forty patients (group 1, n = 164; group 2, n = 119) were identified, with the majority of these admitted due to nonsteroidal anti‐inflammatory drugs (NSAIDs) only. For CCCAs (NSAID‐containing), the same patients were admitted repeatedly with a reduction from 31 to eight admissions (P = 0.005), following rescheduling. The total cost of CCCA admissions was reduced from AU$ 561 691 for group 1 to AU$ 261 764 for group 2 (P < 0.001). Conclusions: Australian rescheduling of CCCAs in 2018 resulted in a reduction in hospital admissions and costs related to GI complications. The cost savings, even in a single hospital department, were substantial. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) has been well documented using questionnaire‐based studies. Here, we examine the agreement between parental‐reported data during childhood with the emphasis on 12‐year‐olds and data from two national Swedish registers to determine whether register data on AR can supplement or replace questionnaire data. Methods: Data were collected from a prospective, longitudinal cohort study of children born in western Sweden in 2003. Parental questionnaires were filled out at 6 months and one, four, eight, and 12 years of age. A total of 3634 children were linked to the Swedish Prescribed Drug Register (SPDR) and the National Patient Register (NPR) using personal identity numbers. The agreement between the register and questionnaire data was estimated using Cohen's kappa with 95% confidence intervals. Results: According to the SPDR, 9.9% (n = 360/3634) of the children were dispensed specific AR medication at 11–13 years of age compared with the 12 years questionnaire where 23% reported AR medication use during the last 12 months. The overall agreement between questionnaire and SPDR data on AR medication was slight (kappa 0.05). At 11–12 years, 1.8% (n = 65/3634) of the children received an outpatient AR diagnosis in the NPR, while 10% reported doctor‐diagnosed AR in the questionnaire. The overall agreement between questionnaire and NPR data on AR diagnosis was slight (kappa 0.16). Conclusions: There was poor agreement between questionnaire and register data regarding AR and dispensed medication. Explanations could include over‐the‐counter drugs and diagnosis in primary care, which are not included in the registers. [ABSTRACT FROM AUTHOR]

This article discusses a case report of a 19-year-old Japanese female who experienced prolonged toxic encephalopathy with electroencephalogram (EEG) abnormalities following an overdose of dextromethorphan (DXM), a widely used cough suppressant. The patient ingested a high dosage of DXM in a suicide attempt, along with other over-the-counter medications. She had a history of intermittent DXM abuse, which resulted in mood elevation and hallucinations. The patient exhibited symptoms such as coma, dilated pupils, tachycardia, and hyperthermia. Her consciousness gradually improved after transfer to the psychiatric unit, and she was discharged without any apparent sequelae. The article highlights the potential psychiatric and neurological outcomes of recreational DXM abuse and emphasizes the need for clinicians to remain vigilant. [Extracted from the article]

Introduction: This study investigates differences in health and well‐being associated with current, past or no injecting drug use (IDU) among people living with HIV (PLHIV) in Australia, identifying key health care considerations between injecting experiences. Methods: Data were extracted from the HIV Futures 9 study; a survey of PLHIV conducted in 2018–2019. Chi‐square and analysis of variance analyses compared clinical and treatment characteristics, major physical and mental comorbidities, sexually transmitted infection diagnoses, and quality of life for those who reported current (last 12 months), past (12+ months ago) or no IDU. Results: Current IDU (n = 106) was associated with higher rates of sexually transmitted infection testing and diagnoses, higher frequency of self‐reported antiretroviral therapy non‐adherence due to drug use and greater social quality of life than past (n = 126) or no IDU (n = 508; total N = 740). Past and current IDUs were associated with more mental illness diagnoses and self‐reported concern about drug use. Past IDU was associated with more physical comorbidities, lower satisfaction with clinical care and greater difficulty in affording health care than current or no IDU. Discussion and Conclusions: Past and current IDUs are associated with unique health concerns. However, past IDU appears to be related to greater dissatisfaction in navigating health care than individuals with current IDU experience. Higher social connection and the types of services being accessed by individuals who currently inject may play a role in shaping service satisfaction. Peer‐based interventions to help support individuals in accessing services that are affirming of their needs is an ongoing priority. [ABSTRACT FROM AUTHOR]

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults is widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a regular cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2023 update, an interprofessional expert panel reviewed the evidence published since the last update (2019) and based on a structured assessment process approved a number of important changes including the addition of new criteria, modification of existing criteria, and formatting changes to enhance usability. The criteria are intended to be applied to adults 65 years old and older in all ambulatory, acute, and institutionalized settings of care, except hospice and end‐of‐life care settings. Although the AGS Beers Criteria® may be used internationally, it is specifically designed for use in the United States and there may be additional considerations for certain drugs in specific countries. Whenever and wherever used, the AGS Beers Criteria® should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision‐making. [ABSTRACT FROM AUTHOR]

Objective: Vitamin B17 tablets are sold (online) as an alternative cancer therapy medication. Its use however is not benign, given that it is metabolised into hydrogen cyanide. We aimed to measure the number of calls received by the New South Wales Poisons Information Centre (NSW PIC) regarding Amygdalin exposures. Methods: A retrospective review of all amygdalin/cyanogenic glycoside product ingestion exposure calls to NSW PIC between 2015 and 2022. Results: There were 120 unique exposure calls. Eighty‐two (68%) were regarding minor exposures, with the remaining 38 (32%) of calls involving patients who had either a signifcant history or symptoms to prompt referral to hospital or were already seeking advice from a treating hospital clinican. Conclusion: There is a significant burden of concern generated from the misuse of cyanogenic glycoside products for cancer prevention and treatment, which can result in hospital admission carrying significant health risk and expenditure. [ABSTRACT FROM AUTHOR]

See the Reply by Semla and Steinman in this issue. [ABSTRACT FROM AUTHOR]

Context: Removing the prescription requirement and making oral contraceptive pills available over the counter (OTC) could increase contraceptive access in the United States. Despite current efforts to make a progestin‐only pill (POP) available OTC, there are no qualitative data exploring the experiences of POP users and their perspectives on making POPs available OTC. Methods: We conducted six online, asynchronous focus group discussions with 36 POP users between July and November 2020. We stratified focus group discussion placement based on three reasons for POP use: breastfeeding, having a contraindication to estrogen (for a reason other than breastfeeding), and for any other reason. We thematically analyzed these data using inductive and deductive coding. Results: The majority of participants described their overall POP experience as positive, mostly because they experienced minor or no side effects and thought the pill was effective. Participants overwhelmingly supported OTC availability of POPs and expressed interest in purchasing an OTC POP. Over one‐third of participants had very limited knowledge or held inaccurate assumptions about POPs before they started using this method and many stressed the need to disseminate accurate information and resources about POPs to the public. Conclusions: Most focus group discussion participants were satisfied with POPs and supported OTC access. While misconceptions and concerns about POPs should be addressed, an OTC POP has the potential to be a safe, effective, and convenient contraceptive option in the United States. [ABSTRACT FROM AUTHOR]

Background: Obtaining accurate medication histories at transitions of care is challenging, but important for patient safety. Prescription exchange services (PES) securely transfer electronic prescription and dispensing records between prescribers and pharmacies, which is potentially useful data for determining medication histories. Aim: To evaluate the accuracy of PES‐derived medication histories. Methods: Prospective observational study, at two Australian tertiary‐referral health services. A convenience sample of adult inpatients was recruited. The main outcome measure was: proportion of patients with ≥1 errors in their PES‐derived pre‐admission medication histories, compared with gold‐standard best‐possible medication histories, including prescribed and non‐prescribed medications, obtained by pharmacists using multiple sources including patient/carer interview. Results: Of 154 patients (median age 76 years; interquartile range (IQR) 64–84 years; median 10.0 pre‐admission medications; IQR 6.0–14.0), 153 (99.4%) had ≥1 errors in their PES‐derived medication history (median 6.0 errors per patient; IQR 4.0–9.0). Excluding when‐required medications, 146 (94.8%) patients had >1 errors (median 4.0 errors per patient; IQR 2.0–6.0). Omission was the most common error, affecting 549 (33.3%) of 1648 current medications (median 3.0; IQR 1.0–5.0 per patient); 396 (72.1%) omissions were over‐the‐counter medicines. Dose‐regimen errors affected 276 (25.1%) of 1099 current medications captured in PES‐derived medication histories (median 1.0 error per patient; IQR 0.0–3.0). Commission errors (medications in PES‐derived histories that were not current) affected 224 (16.9%) of 1323 medications (median 1.0 error per patient; IQR 1.0–2.0). Conclusions: Medication histories derived solely from a cloud‐based medication record repository had a high error rate compared with patients' actual medication use. Like all medication history sources, data from cloud‐based repositories need to be verified with additional sources including the patient and/or their carer. [ABSTRACT FROM AUTHOR]

Prescribing safely for refugees and asylum seekers presents a unique set of challenges. This article discusses some of the issues that need to be addressed, including removing barriers to medicine access and ensuring continuity of care, and outlines the work of the Refugee and Asylum Seeker Service at the Alliance for Better Care. [ABSTRACT FROM AUTHOR]

The challenges facing Africans in Chinese cities have been examined from different perspectives, including healthcare‐related challenges and barriers. However, how they navigate health problems through circulation and transnational practices has received scant attention. The article explored the importance of circulation and everyday transnationalism in health maintenance using qualitative data from 37 Nigerians in Guangdong Province, China. It revealed that transnational practices involving the flows of people, medicinal commodities and information were crucial in managing their health issues with circulating migrants, family members and healthcare professionals at home playing important roles. Circular migrants import herbal medicines and hard‐to‐acquire pharmaceutical drugs between Nigeria and China, family members and relatives also send over‐the‐counter drugs to migrants and health professionals in Nigeria supply medical information through transnational consultation. The article advanced the literature as it responds to the growing call for adopting a transnational lens for interrogating the link between migration and health. [ABSTRACT FROM AUTHOR]

Background and aim: From 1 February 2018, codeine was rescheduled from an over‐the‐counter (OTC) to a prescription‐only medicine in Australia. We used wastewater‐based epidemiology to measure changes in population codeine consumption before and after rescheduling. Methods: We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography–tandem mass spectrometry and converted to per‐capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. Results: Average per‐capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3–39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4–27.0% and 41.8–59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7–61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1–39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2–34.1% versus 34.9–40.4%, respectively) from a base per‐capita usage approximately 40% higher than cities. Conclusion: Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription‐only medicine in 2018. Wastewater‐based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling. [ABSTRACT FROM AUTHOR]

Context: A growing body of evidence supports over‐the‐counter access to oral contraceptives in the United States. An important consideration for over‐the‐counter approval is consumers' ability to understand key package label messages related to safety and effectiveness without clinician involvement. We developed a prototype over‐the‐counter Drug Facts Label for a combined oral contraceptive pill and conducted a pilot label comprehension study to evaluate consumer understanding of key messages for use. Methods: In November–December 2020, we conducted interviews with 163 adults and teens in the United States who were aged 12–49 years and identified as female or another gender but had a uterus and the ability to become pregnant. We developed 11 primary endpoints based on assessment of clinical risks that could occur if consumers fail to heed them, including messages about contraindications and directions for use; 11 secondary endpoints represented additional important information but with lower potential for clinical consequences if not understood. We evaluated endpoint comprehension by computing frequencies, percentages, and 2‐sided Exact (Clopper‐Pearson) 95% confidence intervals for observed proportions. Results: Ten of the 11 primary endpoints and 10 of the 11 secondary endpoints were each understood by ≥95% of participants. The remaining primary endpoint on use with prior blood clots was understood by 89% of participants. The remaining secondary endpoint on the product being designed for "people who have the ability to become pregnant" was understood by 83% of participants. Conclusion: Participants understood the key label information required for safe and effective combined oral contraceptive use without clinician involvement. [ABSTRACT FROM AUTHOR]

Objective: Age‐related comorbidities, polypharmacy and thereby the risk of potential drug–drug interactions (PDDIs) among people living with HIV (PLWH) have increased over the years. We estimated the prevalence of comedications, including dietary supplements, and evaluated PDDIs among PLWH receiving antiretroviral therapy (ART) in Denmark in an outpatient setting. Methods: Information on prescription medication, over‐the‐counter medication and dietary supplements was obtained from adult PLWH receiving ART attending two outpatient clinics in Denmark. The PDDIs were identified using the University of Liverpool's drug interaction database. Associations between PDDIs and relevant variables were compared using logistic regression models. Results: A total of 337 PLWH receiving ART with a median age of 53 years (interquartile range: 45–61) were included; 77% were male and 96% had a HIV‐RNA viral load < 50 copies/mL. Twenty‐six per cent of participants received five or more comedications and 56% consumed dietary supplements. Co‐administration of drugs requiring dose adjustment or monitoring was identified in the medication lists of 52% of participants, and 4.5% were on drugs that should not be co‐administered. Male sex [odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.0–3.4], being on a protease inhibitor (OR = 4.3, 95% CI: 1.9–9.7), receiving five or more comedications (OR = 3.3, 95% CI: 1.5–7.2), taking over‐the‐counter medications (OR = 1.9, 95% CI: 1.1–3.3) and dietary supplements (OR = 2.0, 95% CI: 1.2–3.3) were independent predictors of PDDIs. Conclusion: Potential drug–drug interactions were common among our study population Our study confirms that polypharmacy and being on a protease inhibitor‐based regimen increase the risk of PDDIs considerably and highlights the importance of questioning PLWH about dietary supplement intake. [ABSTRACT FROM AUTHOR]

Background: Branded drugs contribute disproportionately to high prescription drug spending. Pharmaceutical companies utilize patent extension "evergreening" techniques that contribute to high drug costs. Aims: This article describes various patent extension techniques and analyzes the tactic of combining generic drugs with branded drugs, using metformin combinations for diabetes treatment as a case study. It examines the argument that FDCs enhance adherence and compares the cost of several branded fixed‐dose combinations with the cost of their individual constituents. Materials & Methods: We reviewed literature on patent extension techniques in both medical and marketing literature, supplemented by our own extensive files. We performed a price analysis of several branded pharmaceuticals and generically available equivalents. Prescription drug prices were determined using GoodRx.com, and prices of over‐the‐counter products were established based on the prices of two chain wholesalers. Patent and formulation information was taken from the FDA Orange Book: Approved Drugs with Therapeutic Equivalence Evaluations database. Results: "Evergreening" patent extension tactics include the sequential release of different formulations, minor dosing changes, and fixed‐dose combinations (FDCs). A "new use" provides an opportunity for a company to re‐patent, rebrand, and remarket one drug for multiple indications. It is unclear whether or not FDCs enhance adherence. Branded fixed‐dose combinations generally cost far more than their individual constituents. FDCs that combine metformin with other drugs are an exception, often costing the same as the non‐metformin component. Discussion: Patent extension tactics increase drug costs while providing little additional benefit to patients. Minor alterations in formulations or dosing may provide no clinical benefits. Many FDCs are expensive and fail to provide cost‐justified improvements in clinical outcomes, compared to equivalent generic drugs that would save money while delivering an equal standard of care. Combining newer hypoglycemic drugs with metformin, a gold‐standard, generic, inexpensive drug, does not appear to cost more than individual constituents but offers no clinical advantage over metformin alone. Conclusion: Evergreening tactics should be reined in, as they represent significant cost to the healthcare system and to patients. Physicians and other prescribers should avoid prescribing FDCs, or slightly tweaked "new" drugs. Patented drug combinations generate profit without innovation. [ABSTRACT FROM AUTHOR]

The neurochemical mechanisms underlying motor memory consolidation remain largely unknown. Based on converging work showing that ethyl alcohol retrogradely enhances declarative memory consolidation, this work tested the hypothesis that post‐learning alcohol ingestion would enhance motor memory consolidation. In a within‐subject and fully counterbalanced design, participants (n = 24; 12M; 12F) adapted to a gradually introduced visual deviation and ingested, immediately after adaptation, a placebo (PBO), a medium (MED) or high (HIGH) dose of alcohol. The alcohol doses were bodyweight‐ and gender‐controlled to yield peak breath alcohol concentrations of 0.00% in the PBO, ~0.05% in the MED and ~0.095% in the HIGH condition. Retention was evaluated 24 h later through reach aftereffects when participants were sober. The results revealed that retention levels were neither significantly nor meaningfully different in both the MED and HIGH conditions as compared to PBO (all absolute Cohen's dz values < ~0.2; small to negligible effects), indicating that post‐learning alcohol ingestion did not alter motor memory consolidation. Given alcohol's known pharmacological GABAergic agonist and NMDA antagonist properties, one possibility is that these neurochemical mechanisms do not decisively contribute to motor memory consolidation. As converging work demonstrated alcohol's retrograde enhancement of declarative memory, the present results suggest that distinct neurochemical mechanisms underlie declarative and motor memory consolidation. Elucidating the neurochemical mechanisms underlying the consolidation of different memory systems may yield insights into the effects of over‐the‐counter drugs on everyday learning and memory but also inform the development of pharmacological interventions seeking to alter human memory consolidation. [ABSTRACT FROM AUTHOR]

Aims: Inappropriate anticoagulant use increases the risk of bleeding and thrombotic events. We implemented clinical decision rules to promote judicious medication use, as part of the 'Check of Medication Appropriateness' (CMA). The CMA is a pharmacist‐led review service, targeting potentially inappropriate prescriptions (PIPs). In this analysis, we aimed to evaluate the impact of the CMA on anticoagulant prescribing. Methods: The number of anticoagulant‐related PIPs was evaluated before and after implementation of the intervention in a quasi‐experimental interrupted time series analysis. The pre‐implementation cohort received usual care. The anticoagulant‐focused CMA, comprising 13 clinical rules pertaining to anticoagulation therapies, was implemented in the post‐implementation cohort. Segmented regression analysis was used to assess the impact of the intervention on the number of residual PIPs. A residual PIP was defined as a PIP which persisted up to 48 hours after the CMA intervention. Total number of recommendations and acceptance rate were documented for the 2‐year post‐implementation period. Results: Pre‐implementation, we observed 501 PIPs in 466 inpatients on 36 days, with a median proportion of 78.5% (range: 46.2%–100%) residual PIPs per day. Post‐implementation, 538 PIPs were detected in 485 patients over the same number of days. The CMA intervention reduced the median proportion to 18.2% (range: 0–100%) per day. The effect coincided with an immediate relative reduction of 70% (95%CI 0.19–0.46) in anticoagulant‐related residual PIPs. Post‐implementation, 2778 recommendations were provided and 75.1% were accepted. Conclusion: Our CMA approach significantly reduced anticoagulant‐related PIPs. Implementing a pharmacist‐led intervention, based on clinical rules, may support safer prescribing of anticoagulants. [ABSTRACT FROM AUTHOR]

Objective: To identify predictors of acute treatment response for nonprescription (over‐the‐counter [OTC]) medications among people with migraine and develop improved models for predicting treatment response. Background: Pain freedom and sustained pain relief are important priorities in the acute treatment of migraine. OTC medications are widely used for migraine; however, it is not clear which treatment works best for each patient without going through the trial and error process. Methods: A prediction model development study was completed using the 2006 American Migraine Prevalence and Prevention Study survey, from participants who were aged ≥18, met criteria and headache day frequency for episodic migraine, did not take prescription medication for migraine, and used ≥1 of the following acute migraine medication classes: acetaminophen, aspirin, NSAIDs, or caffeine containing combination products (CCP). Two items from the Migraine Treatment Optimization Questionnaire were used to evaluate treatment response, adequate 2‐h pain freedom (2hPF) and 24‐h pain relief (24hPR), which were defined by a response to treatment ≥half the time at 2 h and 24 h post treatment, respectively. We identified predictors of adequate treatment response and developed models to predict probability of treatment response to each medication class. Results: The sample included 3852 participants (3038 [79.0%] females) with an average age of 45.0 years (SD = 12.8). Only 1602/3852 (41.6%) and 1718/3852 (44.6%) of the participants reported adequate 2hPF and 24hPR, respectively. Adequate treatment‐response was significantly predicted by lower average headache pain intensity, less cutaneous allodynia, and lower depressive symptom scores. Lower migraine symptom severity was predictive of adequate 2hPF and fewer monthly headache days was predictive of adequate 24hPR. Among participants reporting OTC monotherapy (n = 2168, 56.3%) individuals taking CCP were more likely to have adequate 2hPF (OR = 1.55, 95% CI 1.23–1.95) and 24hPR (OR = 1.79, 95% CI 1.18–1.88) in comparison with those taking acetaminophen. Predictive models were modestly predictive of responders to OTC medications (c‐statistics = 0.65; 95% CI 0.62–0.68). Conclusion: These results show that response to acute migraine treatments is not optimized in the majority of people with migraine treating with OTC medications. Predictive models can improve our ability to choose the best therapeutic option for individuals with episodic migraine and increase the proportion of patients with optimized response to treatments. [ABSTRACT FROM AUTHOR]

Twenty-seven patients (31.4%) received a first line treatment, 14 (16%) with locally advanced disease and 72 (84%) with metastatic disease; 74 patients (86%) were treated with PD-1 drugs and 12 (14%) with PD-L1. Median treatment duration was 4.9 (IQR: 1.9-17.0) and 5.9 months (IQR: 1.2-12.3) respectively; 75 patients (87.2%) had a total of 353 ADRs: 37 (10.5%) were G3-4, and 3 (1%) G5. 61 (81%) patients needed pharmacological treatment and 6 patients (0.1%) non pharmacological one; 63 patients had 156 (44%) immunorelated ADRs (14% with a latency period of >=12 months). B SECTION: A. EVALUATION AND SELECTION OF MEDICINES b B #44 b B The therapeutic positioning report as a tool for assessment of added therapeutic value (ATV) of medicines b Almudena Ramírez García, Aránzazu Sancho López, Antonio Francisco Caballero Bermejo, Concepción Payares Herrera, Belén Ruiz Antorán and Cristina Avendaño Solá I Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain i B Objective: b The new European Regulation on Health Technology Assessment will force a revision of the Therapeutic Positioning Report (IPT from Spanish abbreviation) procedure which is the basic assessment report in the decision-making process for public financing. The most frequent drugs were antiepileptic drugs (carbamazepine, lamotrigine, and phenytoin, 24%), amoxicillin-clavulanate (13%), antituberculosis drugs (9.1%), and allopurinol (7.3%). [Extracted from the article]

Background and aims: Minor physical ailments are treated with over‐the‐counter (OTC) medications. The availability of OTC drugs helps reduce waiting times and ease the suffering of many. Suicidal behavior includes suicidal ideation, attempts, and completed suicides and affects people of all ages, religions, and cultures. This study aims to review use of OTC drugs for self‐harm and suicidal attempts. Methods: We reviewed English language publications from the beginning of time to October 2021 on OTC drug use for suicidal behavior. Results: Twenty‐seven studies met the eligibility criteria, and 1,816,228 participants were reported in these publications. OTC analgesics and sedatives/hypnotics were frequently used for suicidal behavior. Females and young people mainly were reported to self‐harm using OTC medications. An increase in OTC analgesic use for self‐harm in adolescents during the school months was reported. Elderly persons use hypnotics more frequently for suicidal attempts. Persons with major psychiatric disorders were reported to use OTC for suicidal behavior. Conclusion: The available information shows that the prevention strategies should focus on OTC analgesics and hypnotic use among women, the young, the elderly, and persons with mental health disorders. [ABSTRACT FROM AUTHOR]

Aims: The French Ministry of Health scheduled opioid cough suppressants as prescription‐only drugs on 12 July 2017. The present study assessed the impact of this regulation on the diversion modalities of the concerned drugs and the related drug pholcodine by analysing the national OSIAP (Ordonnances Suspectes Indicateur d'Abus Possible) database. Methods: Medical prescriptions with at least 1 mention of codeine, dextromethorphan, ethylmorphine, noscapine or pholcodine for cough suppression recorded in 2013–2019 were extracted from OSIAP. Annual mentioning rates were estimated by dividing numbers of mentions over those of prescriptions recorded the year considered. A descriptive analysis compared the characteristics of prescriptions before and after 12 July 2017. Results: Overall, 832 mentions of the requested drugs were retrieved on 827 prescription forms. Codeine was the most frequent (n = 809, 8.7%) with 6 additional mentions of codeine/ethylmorphine combination, followed by dextromethorphan (n = 11, 0.1%) and pholcodine (n = 6, 0.1%). There was no mention of noscapine. Annual mentioning rates varied between 0 and 0.3% for all drugs except codeine. Codeine mentioning rates ranged between 0.3% (n = 2) and 0.7% (n = 9) before 12 July 2017 and increased to 10.1% (n = 61) thereafter in 2017, 16.1% (n = 314) in 2018, and 19.8% (n = 414) in 2019. The profile of subjects evolved accordingly with an increased male/female ratio (10.0 vs. 1.5 before) and decreased age (23 vs. 40 y before, P <.001). Discussion: The sharp increase of recourse to falsified prescription forms indicates that codeine diversion continues despite restricted access, whereas the other drugs studied do not seem to have been impacted. [ABSTRACT FROM AUTHOR]

Aim: Wood creosote (WC), an over‐the‐counter (OTC) drug, has been used as an anti‐diarrheal agent for many years; however, its safety in combination with other drugs has not been adequately investigated. The current study was conducted to evaluate whether WC may cause drug interactions through the inhibition of cytochrome P450 (CYP). Methods: The inhibitory effects of WC on ethoxyresorufin O‐deethylation, paclitaxel 6α‐hydroxylation, S‐warfarin 7‐hydroxylation, S‐mephenytoin 4′‐hydroxylation, bufuralol1′‐hydroxylation, and midazolam (MDZ) 1′‐hydroxylation were investigated using human liver microsomes as the marker activities for CYP1A2, CYP2C8, CYP2C9, CYP2C19, CYP2D6, and CYP3A4, respectively. In addition, the effects of single and three‐day multiple treatments of WC (30 mg/kg) on CYP2C‐mediated tolbutamide (TB, 20 mg/kg) and CYP3A‐mediated MDZ (15 mg/kg) metabolism were investigated in rats in vivo. Results: WC at clinical doses did not show a considerable inhibitory effect on any of the CYP activities examined in the in vitro study. CYP2C9 and CYP2C19 activities were inhibited by high concentrations of the WC (100 μg/mL); however, the IC50 values were approximately 70 times higher than the reported circulating levels of the main ingredients in WC. Furthermore, there were no marked changes in the pharmacokinetic parameters of TB and MDZ (area under the serum concentration–time curve, maximum serum concentrations, and elimination half‐life) after single or three‐day multiple treatments with WC. Conclusion: These results suggest that clinical doses of WC are unlikely to cause drug interactions mediated by the inhibition of CYPs. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the influence of over‐the‐counter agents on the maintenance of color and microhardness of the enamel after home bleaching protocol. Materials and methods: Specimens of bovine teeth (6 × 6 × 2 mm) were prepared, and color (Easyshade, VITA) and microhardness (HMV‐2, Shimadzu) readings were performed. All the specimens were bleached using 22% carbamide peroxide (22%CP), except for the control group, and then separated into seven groups (n = 10) according to the interaction of toothpaste (whitening, conventional, and whitening with peroxide) and mouth rinse (whitening and conventional). The study simulated 1 year of toothbrushing (Pepsodent, MAVTEC) and mouth rinse by immersion. After that, final color and microhardness measurements were performed. Data were analyzed by one‐way ANOVA, Tukey's test (P <.05). Results: The group submitted to 22%CP + whitening toothpaste + whitening mouth rinse showed higher color maintenance (P <.05) than the control group. The perception of whitening of teeth (ΔWID) was higher than the color change (ΔE00). There was a decrease in microhardness after treatment with 22%CP + conventional toothpaste + whitening mouth rinse. Conclusions: Over‐the‐counter products can help with the maintenance of tooth whitening after bleaching with carbamide peroxide; however, special attention should be given since the association of products can also reduce the microhardness of the dental enamel. Clinical significance: The association between whitening toothpastes and mouth rinses might be beneficial for maintaining color during 1 year after bleaching treatment. [ABSTRACT FROM AUTHOR]

In the second of this two‐part series on the non‐medical use of prescription‐only medicines (POM) and over‐the‐counter (OTC) medicines, Graham Parsons discusses how to identify and reduce the risk of non‐medical use of medicines, and provides an overview of the treatment options for managing dependence. [ABSTRACT FROM AUTHOR]

In the first of a two‐part series on the non‐medical use of prescription‐only and over‐the‐counter (OTC) medicines, Graham Parsons discusses the prevalence of the problem, the medicines most likely to be misused and the patient groups at highest risk. [ABSTRACT FROM AUTHOR]

In this article, there is established a reverse logistics (RL) system to collect unwanted medications (UMs) in households. A reverse supply chain (RSC) is proposed in a decentralized state including manufacturer, and retailer involving a strategic consumer. The novelty of this article is that the model is investigated from the consumer's perspective, whereas in the previous studies, the proposed models were from other upstream members' perspectives such as manufacturer and retailer. Furthermore, inducement and advertising strategies are proposed for stimulating consumers to engage more in an RSC. To analyse the effect of these two strategies, the three‐person RSC game‐theoretical approach is used. A three‐person supply chain consists of a pharmaceutical manufacturer and a retailer who will interact with a strategic consumer in several non‐cooperative Stackelberg games. Three Stackelberg games are established and, each member takes a turn as a leadership role and the other two players assume the role of the follower. [ABSTRACT FROM AUTHOR]

The article reports that Asthma is a reactive airway disorder typified by wheezing, cough, and shortness of breath impact several million people in the United States. Topics include examines that putting the prevalence in perspective in several individuals in the United States carries a diagnosis of asthma with rates varying on the basis of patient age as well as racial and socioeconomic factors.

Bariatric or weight‐loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended‐release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advice for oral drug therapy after bariatric surgery, implying that a risk assessment on a case‐by‐case basis is required for each drug. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the tooth whitening efficacy of non‐hydrogen peroxide containing mouthrinses. Methods: Forty incisors were randomly assigned into four groups. Four whitening mouthrinses, Oral‐B 3D White Luxe/Procter & Gamble (WL), Listerine Advanced White/Johnson & Johnson (AW), Colgate Max White/Colgate (MW), and iWhite Whitening Mouthwash/Sylphar (iW), were used over a four‐week period. Color changes of L*, a*, b*, ΔE*ab, and ΔE00, were recorded by a digital spectrophotometer (Spectroshade Micro/Mht), at baseline and intermediate week‐intervals. Data were statistically analyzed using repeated measures ANOVA at α = 0.05. Results: The first‐week mean change of L* was 0.76 and significantly different from the baseline for all solutions, without any further changes. Correspondingly, a* decreased by −0.36, while b* increased by 0.48, contributing to a color change of 1.15 ΔE*ab or 0.91 ΔE00. No differences were found among the solutions in respect to color‐parameter changes (p > 0.05). Differences among time intervals were significant (p < 0.05) and mainly observed between the baseline and the following week‐measurements. There was no statistically significant time‐solution interaction (p > 0.05). Conclusions: Non‐hydrogen peroxide whitening mouthrinses, slightly contribute to tooth whitening, by removing superficial staining, without any further tooth bleaching effect. Clinical significance: Non‐hydrogen peroxide containing whitening mouthrinses, despite having a quick initial action, reach their ceiling relatively soon. Their effectiveness is barely perceptible and definitely inferior to other professional tooth bleaching methods. Thus, they can only be considered as a supplementary way of keeping teeth whiter, mainly by preventing recurrent tooth discoloration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Access to unassigned epinephrine is critical for schools to treat anaphylaxis. Low socioeconomic status is associated with decreased access to epinephrine in the school setting. In and around New Orleans, physicians partner with schools to assist with stocking unassigned epinephrine autoinjectors (EAIs). New Orleans' decentralized public charter school district makes widespread adoption challenging. METHODS: Physicians partnered with New Orleans decentralized public charter schools, as well as neighboring centralized public school districts, to perform training on recognizing and treating anaphylaxis, assist with the adoption of school policy for stock epinephrine, and aid with obtaining stock EIAs free‐of‐cost through the EpiPen4Schools® program. We used publicly available school enrollment data and our own calendar records to calculate how many children we covered with stock epinephrine per hour of physician or administrator time. RESULTS: For centralized school districts, we cover approximately 4000 children with stock epinephrine per hour of time. For the decentralized district of New Orleans, we estimate covering only 400 children with stock epinephrine per hour of time. CONCLUSION: Decentralized school districts reduce educational disparities, but require more time and energy to get EAIs in place than centralized school districts do. [ABSTRACT FROM AUTHOR]

Purpose: Pain is common in youngsters. No matter its nature, youngsters' consideration of pain is complex since its communications vary as a function of several components. The aim of this study is to explore the youngsters' perception linked to their experience of physiological pain at the home/family setting, as well as their experience with the utilisation of over‐the‐counter pain medication as needed. Design and methods: A qualitative exploratory study was undertaken with 22 youngsters aged 5–17 years old. Semidirected interviews led to the understanding of these components by means of the pain experiences. Thematic analysis allowed the detection of the themes and subthemes emerging from the verbatim collected with the participants. Results: The way pain is described is influenced by the child's development, previous experiences, and the projection of having pain. The pain communication is influenced by the severity perceived, the beliefs of the youngster experiencing pain, the comparison of the pain communication with his brothers and sisters, as well as the anticipated consequences of expressing his pain. The choice of behaviour towards pain is influenced by self‐management through nonpharmacological management, with medicines if needed, and by family modelization. Practice implications: This study confirms that previous pain experiences, beliefs related to pain tolerance and intended reactions of parents exert influence not only on the communication of pain, but also on youngsters' behaviour towards pain. It is important to consider these elements whenever youngsters' pain is evaluated. [ABSTRACT FROM AUTHOR]

On Dec. 19, 2023, the U.S. Food and Drug Administration approved the first test that uses DNA in assessing whether certain individuals may have an elevated risk of developing opioid use disorder (OUD). As part of a clinical evaluation, the AutoGenomics, Inc. AvertD test is intended to be used prior to first exposure to oral opioid pain medications in patients being considered for a 4–30‐day prescription for the treatment of acute pain, such as in patients scheduled to undergo a planned surgical procedure. [ABSTRACT FROM AUTHOR]

Background/Objectives: Non‐steroidal anti‐inflammatory drugs (NSAIDs) can cause kidney injury, especially in older adults. However, previously reported associations between NSAID use and kidney health outcomes are inconsistent and limited by reliance on serum creatinine‐based GFR estimates. This analysis investigated the association of NSAID use with kidney damage in older adults using multiple kidney health measures. Design: Cross‐sectional and longitudinal analyses. Setting: Multicenter, community‐based cohort. Participants: Two thousand nine hundred and ninty nine older adults in the Health ABC Study. A subcohort (n = 500) was randomly selected for additional biomarker measurements. Exposure: Prescription and over‐the‐counter NSAID use ascertained by self‐report. Measurements: Baseline estimated glomerular filtration rate (eGFR) by cystatin C (cysC), urine albumin‐to‐creatinine ratio (ACR), kidney injury molecule‐1 (KIM‐1), and interleukin‐18 (IL‐18) were measured in 2,999 participants; alpha‐1 microglobulin (α1m), neutrophil gelatinase‐associated lipocalin (NGAL), propeptide type III procollagen (PIIINP), and uromodulin (UMOD) were measured in 500 participants. GFR was estimated three times over 10 years and expressed as percent change per year. Results: Participants had a mean age of 74 years, 51% were female, and 41% African‐American. No eGFR differences were detected between NSAID users (n = 655) and non‐users (n = 2,344) at baseline (72 ml/min/1.73 m2 in both groups). Compared to non‐users, NSAID users had lower adjusted odds of having ACR greater than 30 mg/g (0.67; 95% confidence interval (CI) = 0.51–0.89) and lower mean urine IL‐18 concentration at baseline (−11%; 95% CI = −4% to −18%), but similar mean KIM‐1 (5%; 95% CI = −5% to 14%). No significant differences in baseline concentrations of the remaining urine biomarkers were detected. NSAID users and non‐users did not differ significantly in the rate of eGFR decline (−2.2% vs ‐2.3% per year). Conclusion: Self‐reported NSAID use was not associated with kidney dysfunction or injury based on multiple measures, raising the possibility of NSAID use without kidney harm in ambulatory older adults. More research is needed to define safe patterns of NSAID consumption. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance control programmes often aim to "fix" the behaviour of antibiotic users and prescribers. Such behavioural interventions have been widely criticised in social science literature for being inefficient and too narrow in scope. Drawing on these criticisms, this article analyses how political programmes for fixing antibiotic behaviours were adapted into the practices of health‐care professionals and patients in Russia. In 2018, we conducted interviews with medical doctors, pharmacists and patients in a Russian city; focusing on their practices around the policy requirement introduced in 2017 which obligated medical prescriptions of antibiotics. We conceptualised the obligatory medical prescription as a political technique which sought to change practices of self‐treatment and over‐the‐counter sales of medications by establishing doctors as an obligatory passage point to access antibiotics. Our analysis shows that the requirement for medical prescriptions does not fulfil the infrastructural gaps that influence antibiotic practices. By navigating the antibiotic prescriptions, doctors, pharmacists and patients informally compensate for the gaps in the existing infrastructure creating informal networks of antibiotic care parallel to the requirement of obligatory prescriptions. Following these informal practices, we could map the inconsistencies in the current policy approaches to tackle AMR as a behavioural rather than infrastructural problem. [ABSTRACT FROM AUTHOR]

Pediatric transplant recipients are on multiple prescription and non‐prescription drugs. Many patients also use dietary, nutritional, and herbal supplements. This manuscript researched formulations of immunosuppressive drugs currently available and presents information on generic immunosuppressive drugs, commonly used non‐prescription medications, dietary supplements, and herbal supplements. Immunosuppressive drugs are available in various formulations. Not all formulations are interchangeable. A number of FDA‐approved generic formulations are available commercially in the United States. Generally generic formulations produce similar blood concentration vs time profiles compared to brand name products in adults and are considered to be bioequivalent. NSAID should be avoided in transplant patients due to potential drug interactions and increased risk associated with NSAID use; and appropriate doses of acetaminophen should be used for treatment of pain. Over‐the‐counter medications, such as guaifenesin and dextromethorphan, antihistamine medications, including diphenhydramine, loratadine, cetirizine, and fexofenadine, can be safely used in pediatric solid organ transplant population. Many safe and effective over‐the‐counter options exist for stool softening and as laxative. Diarrhea can lead to an increase in calcineurin inhibitor levels. Food can alter the absorption of immunosuppressive drugs. Several herbal products can alter immune status of the patients or alter the blood concentration of immunosuppressive drugs or may produce renal or hepatic toxicities and should be avoided in pediatric transplant recipients. It is important to educate pediatric transplant recipients and their families about not only immunosuppressive drug therapy but also about non‐prescription drugs, dietary, and herbal supplement use. [ABSTRACT FROM AUTHOR]

Acetaminophen (AAP; or paracetamol) is a widely used nonprescription drug with antipyretic and analgesic properties. Alarmingly, there is an increasing body of evidence showing that developmental exposure to AAP is associated with adverse behavioural outcomes later in life. We have previously shown that relevant doses of AAP in 10‐day‐old mice affected memory, learning and locomotor activity in the adult animals. Interestingly, the neurons of the dentate gyrus (DG) have a relatively late time of origin as they are generated during the first two weeks of postnatal life in rodents. Since the generation of these cells, which are important for memory processing, coincides with our AAP exposure, we aim to investigate if the cytoarchitecture of the DG is affected by postnatal day 10 AAP treatment. In addition, we investigate if markers for differentiation and migration in the hippocampus were affected by the same treatment. We did not observe any visual effects in adult DG cytoarchitecture, nor any changes of markers for differentiation/migration in the hippocampus in 24 hr after exposure. Even though a large effect size was estimated on adult DG thickness following AAP exposure, the estimated 95% CIs around the differences of the means reveal no significant effect. Hence, larger sample sizes are warranted to clarify if neonatal AAP exposure affects adult DG thickness in mice. [ABSTRACT FROM AUTHOR]

The means by which patients acquire their medications differ between countries, and a knowledge of this is essential when conducting and interpreting pharmacoepidemiological studies. The aim of this paper is to provide an overview of how patients obtain medicines in Denmark, to relate these to nationwide registries available for research and to discuss the implications for research. Health services are predominantly tax‐funded in Denmark, with dentistry and some medicine bought at community pharmacies being exceptions, involving partial reimbursement of charges. The paper gives an overview of prescription medicines acquired from community pharmacies (including magistral preparations), over‐the‐counter medicines, vaccinations and in‐hospital medicine including so‐called "free medicine" (in Danish: "vederlagsfri medicin"). "Free medicine" is medicines for a defined list of diseases and indications that is provided free of charge to patients in outpatient clinics. The paper also describes the content of the various Danish data sources about medicine use, summarizes their strengths and limitations, and exemplifies the ways of evaluating their completeness. An example is provided of the regional variation in the means by which medicines are acquired. [ABSTRACT FROM AUTHOR]

Paracetamol (acetaminophen) is the most commonly used over‐the‐counter (OTC) drug in the world. Despite its popularity and use for many years, the safety of its application and its mechanism of action are still unclear. Currently, it is believed that paracetamol is a multidirectional drug and at least several metabolic pathways are involved in its analgesic and antipyretic action. The mechanism of paracetamol action consists in inhibition of cyclooxygenases (COX‐1, COX‐2, and COX‐3) and involvement in the endocannabinoid system and serotonergic pathways. Additionally, paracetamol influences transient receptor potential (TRP) channels and voltage‐gated Kv7 potassium channels and inhibits T‐type Cav3.2 calcium channels. It also exerts an impact on L‐arginine in the nitric oxide (NO) synthesis pathway. However, not all of these effects have been clearly confirmed. Therefore, the aim of our paper was to summarize the current state of knowledge of the mechanism of paracetamol action with special attention to its safety concerns. [ABSTRACT FROM AUTHOR]

On July 28, the Food and Drug Administration (FDA) approved the second over‐the‐counter naloxone nasal spray product. So, it's not just "Narcan" anymore. [ABSTRACT FROM AUTHOR]

Paracetamol (PAR) is the most frequently consumed non‐prescription drug, yet it is well known to induce toxicity. Here, we have evaluated the effects of exercise training on vascular dysfunction induced by PAR. Rats were distributed among four groups: (a) Sedentary; (b) Exercise; (c) Sedentary+PAR; and (d) Exercise+PAR. The exercise comprised swimming 50 min/d, 5 d/wk for 6 weeks (+PAR in the last 2 weeks, at 400 mg/kg/d/p.o.). After killing, the rats' blood and aortas were collected for biochemical analysis of hepatic transaminases, TBARs reaction, glutathione, glutathione reductase, SOD, and catalase. In vitro vascular relaxation was measured using acetylcholine and sodium nitroprusside in the presence or absence of tiron (an antioxidant). Vascular protein expression (eNOS and sGC) also were analysed. Increased transaminases after PAR treatment were found to be reduced by exercise. Vasodilation was impaired by PAR only in the sedentary group. Exercise prevented alterations in lipoperoxidation and glutathione levels after PAR exposure. Glutaathione reductase and SOD also were increased by PAR but were normalized in the exercised group. Catalase activity and protein expressions did not change in any group. PAR treatment caused impairment in both vasodilation and redox balance; however, exercise training prevented the vascular and redox system dysfunction induced by PAR treatment. [ABSTRACT FROM AUTHOR]

When new drugs are approved by the Food and Drug Administration, the default assumption is that they will be available by prescription only, safe for use exclusively under clinical supervision. The paternalism underlying this default must be interrogated in order to ensure appropriate respect for patient autonomy. Upon closer inspection, prescription requirements are justified when nonprescription status would risk harm to third parties and when a large segment of the population would struggle to exercise their autonomy in using a drug safely and effectively on their own. Although these justifications can support prescription status for many drugs, we propose that reversing the FDA's current default to instead begin with a presumption in favor of over‐the‐counter status is the best way to avoid interference with valid claims of patient autonomy. Under this approach, a range of drug products could be considered for an OTC switch, including oral contraceptives, statins, and HIV‐prevention drugs. [ABSTRACT FROM AUTHOR]